Evaluation of studies investigating the effectiveness of pharmacists' clinical services

A quantitative evaluation of randomized trials of counseling, education, an d other clinical services provided by pharmacists was performed. Data sources were MEDLINE and the bibliographies of published articles. Pha rmacists' services were categorized as counseling of patients, counseling o f physicians, counseling of both patients and physicians, and patient care. The outcomes extracted were measures of patient behavior, disease, symptom s, and patient knowledge. Thirty-two trials met the inclusion criteria. The pharmacists were specifie d as clinical pharmacists in 24 trials and as community pharmacists in 2. I n six unblinded trials of patient counseling, the outcomes favored the coun seled patients over control patients in every trial, and the effects were s tatistically significant in five trials the outcome was medication adherenc e in these five trials. In seven trials of counseling of both patients and their physicians, patient outcomes were significantly better in the interve ntion group in six trials, four of wh ich were single blind. Two trials in which patients were randomized to either physician counseling or control gr oups yielded inconsistent results. In one trial in which physicians were ra ndomized to receive counseling from pharmacists, the proportion of prescrip tions meeting guidelines was higher in the counseling group than in the con trol group. Four trials of patient care by pharmacists were inconclusive. These trials demonstrated that counseling of patients and their physicians by pharmacists can improve patient outcomes. The evidence that counseling o f patients alone improved patient outcomes was good, though weaker because of suboptimal trial design.